What are the roles of Advanced Practice Nurse's (APN) employed
by health care organizations in your community in quality
improvement activities? Are APNs leaders of quality improvement
teams? What significant contributions have occurred as a result
of APN involvement on Quality Improvement (QI) teams? Do you
know of any Evidence Based Practice activities in your area that
APNs have spearheaded?
Advanced Practice Nurses (APN) is changing the way the healthcare system has
done business for years. With the new healthcare laws that focus on preventive care
APNs have taken the initiative and have stepped up to the challenge. As we have seen
there is an increase shortage in physicians and APN are currently being accepted and
welcomed into the patient health care team as primary nonphysician provider that
provides care for the patient in place of the physician (Hariharan, 2015). In my current
position there are only two APN that work in the hospice organization. The one that I am
most familiar with is a Clinical Nurse Specialist whom specializes in wound care. She is
a great asset to our department and leads the way in wound education. She is a great
resource, she loves to make home visit with us when new or worsening wounds arise and
will give her recommendation. She is a leader and a co-worker. She works closely with us
staff nurses and gives recommendations and she always asks our opinion. She is a great
example of a transformational leader. She doesn’t come in and try to control the situation
she asks questions and together we coordinate and integrate an appropriate plan of care.
(McEwen & Wills, 2014)
Recently, we had a Medicare audit and the one thing that they pointed out could
be improved was our wound documentation including measurements, wound
care/dressing change orders, as well as patient education to prevent wound care. Our
CNS, Marilyn spearheaded several short education sessions during our monthly staff
meeting with handouts. She also rounded with each of us home care nurses on a few of
our patients that have wounds. Our patient’s wounds have greatly decreased in this six-
month period as well as patient satisfaction with integumentary and wound care. Marilyn,
seen this as an opportunity to lead this quality improvement that we were lacking in.
Honestly, a large part of it was there was nowhere in our tablets to give a good
description of the wound so in this entire process we also had that initiated in our
program to have an appropriate place to document the wound and the wounds
characteristics.
Before working as a hospice nurse I worked in CVICU and then transferred to
Sanger Heart and Vascular Clinic where I worked as an outpatient nurse. This is another
area I really seen APNs stepping up the challenge and really making a difference in-
patient care. The APNs stayed in close contact with patients recently discharged from the
hospital with a cardiac event. The patients were given follow-up visit within 48 hours as
well as another follow up in one to four weeks depending on the patients need. APNs
played a huge role in decreasing the rate of readmission. During these visits medications
were discussed thoroughly and questions were answered. A typical APN visit slot was
thirty to forty-five minutes where as physicians are slotted every fifteen minutes. This in
itself shows you the difference that the APNs make in patient care and education.
As stated above hospital readmission decrease significantly from APNs within our
cardiac patients. Patient safety and satisfaction improved significantly due to patients felt
informed and comfortable with the education they have been provided with their
medications and lifestyle choices they need to make to improve their health. In my
current environment we have seen an improvement in wounds and the wound care that is
being provided. We are kept up-to-date and aware of new wound care suggestions based
on evidence-based practice. Personally, I have found this to be a great asset and I have
learned a great deal from our wound care nurse specialist. I feel more comfortable after
working with her and her sharing her knowledge with our team. It is a great feeling to
know that she is a phone call away if a situation arises or if I am questioning if another
dressing would offer more benefit to the patient. I have worked with a number of APNs
in different setting from inpatient, outpatient, as well as in hospice they have all been
willing to work with us nurses and they seem eager to teach others and are open to
learning opportunities themselves. I am partial to APNs because I truly believe that their
nursing background is one of their great assets, they have that caring attitude towards the
patient and strives to be the patient advocate while still providing advance care. It is my
hope that our hospice organization will start looking at employing more APNs, it has
been brought up in several situations, I have voiced my support in more positions for
APNs as I believe they make a huge contribution to our health care system, patient care,
and in quality improvement.
Hariharan, S. (2015). USING ADVANCE PRACTICE REGISTERED NURSES AND
PHYSICIAN ASSISTANTS TO EASE PHYSICIAN SHORTAGE. Physician
Leadership Journal, 2(3), 46-51.
McEwen, M., & Wills, E. (2011). Grand nursing theories based on interactive process.
Theoretical basis for nursing (3rd ed., p102-186). Philadelphia, PA: Lippincott,
Williams & Wilkins.
